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DEMOGRAPHIC AND HEALTH SURVEY IN MALI -EDSM III, 2001 MEN'S QUESTIONNAIRE

IDENTIFICATION

PLACE NAME_____
CLUSTER NUMBER_____
HOUSEHOLD NUMBER______
NAME OF HEAD OF HOUSEHOLD_____
REGION_____
CIRCLE_____

URBAN/RURAL?

URBAN 1
RURAL 2

BAMAKO/OTHER CITIES/OTHER VILLAGES/RURAL?

BAMAKO 1
OTHER CITIES 2
OTHER VILLAGES 3
RURAL 4

NAME AND LINE NUMBER OF MAN_____

INTERVIEWER VISITS

INTERVIEWER 1 (REPEAT FOR SECOND AND THIRD INTERVIEWERS)
DATE _____
INTERVIEWER NAME____

RESULT___

1 COMPLETED
2 NOT AT HOME
3 POSTPONED
4 REFUSED
5 PARTIALLY FILLED OUT
6 INCAPACITATED
7 OTHER (SPECIFY) ____

NEXT VISIT
DATE _____
TIME _____

FINAL VISIT
DAY _____
MONTH _____
YEAR 2001
INTERVIEWER_____
RESULTS_____

TOTAL NUMBER OF VISITS _____

LANGUAGE OF QUESTIONNAIRE: FRENCH 01

LANGUAGE OF INTERVIEW:

FRENCH 01
BAMBARA/MALINKE 02
SONRAI/DJERMA 03
PEUHL/FOULFOULDE 04
MARKA/SONINKE 05
SENOUFO 06
DOGON 07
MINIANKA 08
TAMACHECK/BELLA 09
BOBO/DAFING 10
BOZO/SONOMO 11
OTHER 96

SUPERVISOR
NAME_____
DATE_____

FIELD EDITOR
NAME_____
DATE_____

OFFICE EDITOR_____
KEYED BY_____

INTERVIEWER VISITS
DATE_____

CONSENT STATEMENT AFTER INFORMATION

Hello. My name is_____ and I work for the Minister of Health and the Minister of Planning. We are conducting a national survey that asks about the health of men, women, and children. We would very much appreciate your participation in this survey. I would like to ask you questions about yourself and your family. This information will be useful to the government for planning health services. The interview usually takes 20-30 minutes. The information that you give us will be strictly confidential.

Participation in this survey is voluntary and you can refuse to respond to particular questions or to all of the questions. We hope, however, that you will accept to participate in this survey because your opinion is important to us.

Do you have questions about the survey?
Can I begin the interview now?

SIGNATURE OF INTERVIEWER _____
DATE _____

THE RESPONDENT AGREES TO BE INTERVIEWED 1 (CONTINUE)
THE RESPONDENT DOES NOT AGREE TO BE INTERVIEWED 2 (END)

SECTION 1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENT

101. RECORD THE TIME.

HOUR ____
MINUTES ____

To begin, I would like to ask you questions about yourself and your household.

102. Until the age of 12 years, did you live the majority of the time in Bamako, in another capital, in a city or in a rural area? IF FOREIGNER SPECIFY THE PLACE OF RESIDENCE.

BAMAKO 1
OTHER CITIES 2
OTHER COMMUNES 3
OTHER CITIES IN OTHER COUNTRIES 4
RURAL AREA 5
FOREIGNER WITHOUT SPECIFICATION 6

103. How long have you been living continuously in (NAME OF CURRENT CITY/VILLAGE OF RESIDENCE)?
IF LESS THAN A YEAR, RECORD '00' YEARS.

YEARS_____

ALWAYS 95 (GO TO 105)
VISITOR 96 (GO TO 105)

104. Just before you moved here, did you live in Bamako, another capital, a city, or village?
IF FOREIGNER SPECIFY PLACE OF RESIDENCE.

BAMAKO 1
OTHER CITIES 2
OTHER COMMUNES 3
OTHER CITIES IN OTHER COUNTRIES 4
RURAL AREA 5
FOREIGNER WITHOUT SPECIFICATION 6

105. In which month and in which year were you born?

MONTH ___
DOESN'T KNOW MONTH 98
YEAR 19 ___
DOESN'T KNOW YEAR 9998

106. How old were you at your last birthday?
COMPARE AND CORRECT 106 AND/OR 106 IF INCONSISTENT

AGE IN COMPLETED YEARS ___

107. Did you ever go to school?

YES 1
NO 2 (GO TO 111)

108. What is the highest level of school you attended: primary (first cycle), primary (second cycle), secondary (high school or technical) or superior?

PRIMARY 1 (FIRST CYCLE) 1
PRIMARY 2 (SECOND CYCLE) 2
SECONDARY (HIGH SCHOOL/TECHNICAL) 3
SUPERIOR 4
OTHER (SPECIFY) _____ 6

109. What is the highest (grade/year) you achieved at this level?
CODE '00' FOR LESS THAN A YEAR COMPLETED AND '98' FOR DOESN'T KNOW.

GRADE ____
00 LESS THAN ONE YEAR COMPLETED
98 DOESN'T KNOW

109A. CHECK 106:

24 YEARS OLD OR YOUNGER (GO TO 109B)
25 YEARS OLD OR OLDER (GO TO 110)

109B. Are you currently going to school?

YES 1 (GO TO 110)
NO 2

109C. What is the main reason why you stopped going to school?

TO TAKE CARE OF YOUNGER CHILDREN 03
FAMILY NEEDED HELP IN THE FIELD/WORK 04
COULD NOT AFFORD THE COST 05
HAD TO EARN MONEY 06
EDUCATED ENOUGH 07
FAILED AT SCHOOL 08
NO LONGER LIKED SCHOOL 09
SCHOOL INACCESSIBLE/TOO FAR 10
OTHER (SPECIFY) ____ 96
DOESN'T KNOW 98

110. CHECK 108:

PRIMARY 1 (GO TO 111)
PRIMARY 2 OR HIGHER (GO TO 114)

111. Now I would like you to read this sentence out loud: read as much as you can.
SHOW THE CARD TO THE RESPONDENT.

IF THE RESPONDENT CANNOT READ THE WHOLE PHRASE, INSIST: Can you read certain parts of the phrase to me?

CANNOT READ AT ALL 1
CAN READ SOME PARTS 2
CAN READ THE WHOLE PHRASE 3
NO CARD IN THE RIGHT LANGUAGE (SPECIFY LANGUAGE) _____ 4

112. Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)?

YES 1
NO 2 (GO TO 113)

112A. In which kind of literacy program did you participate?
PROBE: Any other?
RECORD ALL MENTIONED

MEDERSA A
BAMBARA B
PEULH C
TAMACHECK D
SONGHOI E
OTHER (SPECIFY) ____ X

113. CHECK 111:

CODE '2', '3' OR '4' CIRCLED (GO TO 114)
CODE '1' CIRCLED (GO TO 115)

114. Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

115. Do you listen to the radio almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

116. Do you watch television almost every day, at least once a week, less than once a week or not at all?

ALMOST EVERY DAY 1
AT LEAST ONCE A WEEK 2
LESS THAN ONCE A WEEK 3
NOT AT ALL 4

117. What is your religion?

MUSLIM 1
CHRISTIAN 2
ANIMIST 3
OTHER (SPECIFY) _____ 6

117A. Are you Malian?

YES 1
NO 2 (GO TO 119A)

118. What is your ethnicity?

BAMBARA 01
MALINKE 02
PEUHL 03
SARAKOLE/SONINKE/MARKA 04
SONRAI 05
DOGON 06
TAMACHECK 07
SENOUFO/MINIANKA 08
BOBO 09
OTHER (SPECIFY) ____ 96

119A. Do you currently have some sort of job?

YES 1 (GO TO 119C)
NO 2

119B. During the last 12 months did you have any type of job?

YES 1
NO 2 (GO TO 119L)

119C. What is (was) your occupation, that is to say, what kind of work do (did) you mainly do?

OCCUPATION ______

119D. CHECK 119C:

WORKS IN AGRICULTURE (GO TO 119E)
DOES NOT WORK IN AGRICULTURE (GO TO 119F)

119E. Do you work on your own land or your family's land, or land that you rent, or someone else's land?

OWN LAND 1
FAMILY LAND 2
RENTED LAND 3
SOMEONE ELSE'S LAND 4
OTHER (SPECIFY) ____ 6 (GO TO 119G)

119F. Do you do this work for a member of your family, for someone else, or are you self-employed?

FOR A MEMBER OF THE FAMILY 1
FOR SOMEONE ELSE 2
SELF-EMPLOYED 3

119G. Do you usually work at home or away from home?

AT HOME 1
AWAY FROM HOME 2

119H. Do you work all year, seasonally, or occasionally?

ALL YEAR 1
SEASONALLY/PART OF THE YEAR 2
OCCASIONALLY 3

119I. Are you paid in cash or in kind for this work or are you not paid at all?

CASH ONLY 1
MONEY AND KIND 2
IN KIND ONLY 3 (GO TO 119L)
NOT PAID 4 (GO TO 119L)

119J. Who decides how the money you earn will be used?

THE RESPONDENT HIMSELF 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5

119K. On average, how much of your household 's expenses are paid by what you earn: almost nothing, less than half, about half, more than half or all?

ALMOST NONE 1
LESS THAN HALF 2
ABOUT HALF 3
MORE THAN HALF 4
ALL 5
NONE, ALL EARNINGS ARE KEPT 6

119L. In your family who generally has the last word in the following decisions:

Your own healthcare?
The purchase of major things for the household?
The purchase of things for daily household needs?
The visits to family or parents?
What food will be prepared each day?

OWN HEALTHCARE
THE RESPONDENT HIMSELF 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
PURCHASING MAJOR THINGS
THE RESPONDENT HIMSELF 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
PURCHASING MINOR THINGS
THE RESPONDENT HIMSELF 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
FAMILY VISITS
THE RESPONDENT HIMSELF 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6
DAILY FOOD PREPARATION
THE RESPONDENT HIMSELF 1
WIFE/PARTNER 2
RESPONDENT AND WIFE/PARTNER TOGETHER 3
SOMEONE ELSE 4
RESPONDENT AND SOMEONE ELSE TOGETHER 5
DECISION NOT MADE/NOT APPLICABLE 6

119N. Sometimes a husband can get upset or angry because a certain things his wife does. In your opinion, is a husband justified in beating or hitting his wife in the following situations:

If she goes out without telling him?
If she neglects the children?
If she expresses her opinions?
If she refuses to have sexual intercourse with him?
If she burns the food?

GOES OUT
YES 1
NO 2
DOESN'T KNOW 8
NEGLECTS CHILDREN
YES 1
NO 2
DOESN'T KNOW 8
OPINION
YES 1
NO 2
DOESN'T KNOW 8
REFUSES SEX
YES 1
NO 2
DOESN'T KNOW 8
BURNS FOOD
YES 1
NO 2
DOESN'T KNOW 8

SECTION 2: REPRODUCTION

Now, I want to talk to you about any children you have had during your life. I am interested in all of the children that are biologically yours (not those who have a different father).

201. Do you have any children?

YES 1
NO 2 (GO TO 206)
DOESN'T KNOW 8 (GO TO 206)

202. Do you have any sons or daughters that are currently living with you?

YES 1
NO 2 (GO TO 204)

203. How many sons are living with you?
And how many daughters are living with you?
IF NONE, RECORD '00'.

SONS AT HOME ____
DAUGHTERS AT HOME ____

204. Do you have any sons or daughters who are alive but do not with you?

YES 1
NO 2 (GO TO 206)

205. How many sons are alive but do not live with you?
And how many daughters are alive but do not live with you?
IF NONE, RECORD '00'.

SONS ELSEWHERE ____
DAUGHTERS ELSEWHERE ____

206. Do you have any sons or daughters who were born alive but died afterward?
IF NONE, PROBE: Any baby who cried or showed signs of life but survived only a few days or a few hours?

YES 1
NO 2 (GO TO 208)
DOESN'T KNOW 8 (GO TO 208)

207. How many sons have died?
And how many daughters have died?
IF NONE, RECORD '00'.

SONS DEAD ____
DAUGHTERS DEAD ____


208. SUM ANSWERS TO QUESTIONS 203, 205, AND 207 AND ENTER THE TOTAL.
IF NONE, RECORD '00'.

TOTAL ____

209. CHECK 208:
I want to make sure that I have this right: You have had in total _____ children during your life. Is that correct?

YES (GO TO 210)
NO (PROBE AND CORRECT 201-208 AS NECESSARY)

210. CHECK 208:

HAS HAD CHILDREN (GO TO 210A)
HAS NOT HAD ANY CHILDREN (GO TO 301)

210A. In what year was your youngest child born?

YEAR ____

210B. When you were expecting your last child, did you want to have a child at that time, did you want to wait until later, or did you not want to have any (more) children at all?

THEN 1
LATER 2
NOT AT ALL 3

SECTION 3. CONTRACEPTION

Now, I would like to ask you questions about family planning - the various ways or methods that couples can use to delay or avoid pregnancy.

CIRCLE CODE '1' IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN CONTINUE TO COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE '1' IF THE METHOD IS RECOGNIZED AND CODE '2' IF IT IS NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE '1' CIRCLED IN 301, GO TO 302.

301. What ways or method have you heard about?
FOR EACH METHOD NOT MENTIONED SPONTANEOUSLY, ASK: Have you heard of (METHOD)?

01. FEMALE STERILIZATION. Women can have an operation to avoid having any more children.
YES 1
NO 2
02. MALE STERILIZATION. Men can have an operation to avoid having any more children.
YES 1
NO 2
03. PILL. Women can take a pill each day to avoid becoming pregnant.
YES 1
NO 2
04. IUD. Women can have a doctor, midwife, or nurse place a loop or coil inside them.
YES 1
NO 2
05. INJECTIONS. Women can have an injection by a health provider to avoid pregnancy for a month or more.
YES 1
NO 2
06. IMPLANTS. Women can have several small rods inserted in their upper arm by a doctor or nurse that can prevent pregnancy for a year or longer.
YES 1
NO 2
07. CONDOM. Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM. Women can put a sheath inside their vagina before sexual intercourse.
YES 1
NO 2
09. DIAPHRAGM. Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. FOAM OR JELLY. Women can place a suppository, jelly or cream in their vagina before sexual intercourse.
YES 1
NO 2
11. AMENORRHEA/LACTATIONAL METHOD. For up to six months after giving birth, a woman can use this method by breastfeeding often, day and night, so that her menstrual cycle does not return.
YES 1
NO 2
12. RHYTHM METHOD. Each month that a woman is sexually active, she can prevent pregnancy by avoiding having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13. WITHDRAWAL. Men can be careful and pull out before climax.
YES 1
NO 2
14. MORNING AFTER PILL. Women can take a pill up to three days after having sexual intercourse to avoid pregnancy.
YES 1
NO 2
15. Have you heard of any other ways or methods that women or men can use to avoid pregnancy? LIST UP TO TWO METHODS.
(SPECIFY) _____
YES 1
NO 2

302. Have you used (METHOD)?

01. FEMALE STERILIZATION. Women can have an operation to avoid having any more children. Have you ever had a spouse or partner that had an operation to avoid having more children?
YES 1
NO 2
02. MALE STERILIZATION. Men can have an operation to avoid having any more children. Have you ever had an operation to avoid having more children?
YES 1
NO 2
03. PILL. Women can take a pill each day to avoid becoming pregnant.
YES 1
NO 2
04. IUD. Women can have a doctor, midwife or nurse place a loop or coil inside them.
YES 1
NO 2
05. INJECTIONS. Women can have an injection by a health provider to avoid pregnancy for a month or more.
YES 1
NO 2
06. IMPLANTS. Women can have several small rods inserted in their upper arm by a doctor or nurse that can prevent pregnancy for a year or longer.
YES 1
NO 2
07. CONDOM. Men can put a rubber sheath on their penis before sexual intercourse.
YES 1
NO 2
08. FEMALE CONDOM. Women can put a sheath inside their vagina before sexual intercourse.
YES 1
NO 2
09. DIAPHRAGM. Women can place a diaphragm in their vagina before sexual intercourse.
YES 1
NO 2
10. FOAM OR JELLY. Women can place a suppository, jelly or cream in their vagina before sexual intercourse.
YES 1
NO 2
11. AMENORRHEA/LACTATIONAL METHOD. For up to six months after giving birth, a woman can use this method by breastfeeding often, day and night, so that her menstrual cycle does not return.
YES 1
NO 2
12. RHYTHM METHOD. Each month that a woman is sexually active, she can prevent pregnancy by avoiding having intercourse on the days of the month she is most likely to get pregnant.
YES 1
NO 2
13. WITHDRAWAL. Men can be careful and pull out before climax.
YES 1
NO 2
14. MORNING AFTER PILL. Women can take a pill up to three days after having sexual intercourse to avoid pregnancy.
YES 1
NO 2
15. OTHER METHOD(S) (SPECIFY) _____
YES 1
NO 2

303. CHECK 302:

NOT ONE "YES" (NEVER USED) (GO TO 304)
AT LEAST ONE "YES" (EVER USED) (GO TO 307)

304. Have you ever used or tried any way or method to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 401)

305. What method have you used?
CORRECT 302 AND 303 (AND 301 IF NECESSARY)

306. CHECK 302 (02):

RESPONDENT NOT STERILIZED (GO TO 307)
RESPONDENT STERILIZED (GO TO 308A)

307. At this moment, are you using a method to delay or avoid pregnancy?

YES 1
NO 2 (GO TO 401)

308. What method do you use?
308A. CIRCLE 'B' FOR MALE STERILIZATION.

FEMALE STERILIZATION A
MALE STERILIZATION B
PILL C
IUD/COIL D
INJECTIONS E
IMPLANTS F
CONDOM G
FEMALE CONDOM H
DIAPHRAGM I
FOAM OR JELLY J
AMEN. LAC. METHOD K
RHYTHM METHOD L
WITHDRAWAL M
OTHER (SPECIFY) _____ X

SECTION 4. MARRIAGE AND SEXUAL ACTIVITY

401. Are you currently married or living with a woman?

YES, CURRENTLY MARRIED 1 (GO TO 405)
YES, LIVING WITH A WOMAN 2 (GO TO 405)
FIRST UNION NOT CONSUMMATED 3 (GO TO 410)
NO, NOT IN A UNION 4

402. Have you ever been married or lived with a woman?

YES, HAS BEEN MARRIED 1
YES, LIVED WITH A WOMAN 2 (GO TO 407)
NO 3 (GO TO 410)

404. What is your current marital status: are you widowed, divorced, or separated?

WIDOWED 1 (GO TO 407)
DIVORCED 2 (GO TO 407)
SEPARATED 3 (GO TO 407)

405. How many spouses or partners do you currently have?

NUMBER OF SPOUSES ____

406. RECORD THE LINE NUMBER FROM THE HOUSEHOLD SHEET FOR EACH SPOUSE/PARTNER. IF A WOMAN IS NOT LISTED IN THE QUESTIONNAIRE, RECORD '00'. THE NUMBER OF SPACES FILLED OUT SHOULD EQUAL THE NUMBER OF SPOUSES/PARTNERS LISTED IN 405.

LINE NO. ____

407. Have you been married or have you ever lived with a woman only once or more than once?

ONLY ONCE 1
MORE THAN ONCE2

408. CHECK 407:

MARRIED/LIVED WITH A WOMAN ONE TIME: In what month and year did you begin living with your spouse/partner?

MARRIED/LIVED WITH A WOMAN MORE THAN ONCE: Now, I would like to talk about your first spouse/partner. In what month and year did you begin living with her?

MONTH ____
DOESN'T KNOW MONTH 98
YEAR ____ (GO TO 410)
DOESN'T KNOW YEAR 9998

409. How old were you when you began living with her?

AGE IN YEARS _____

Now, I would like to ask you questions about your sexual activity in order to gain a better understanding of some challenges in family life.

410. How old were you when you first had sexual intercourse (if you already have)?

NEVER 00 (GO TO 420)

AGE IN YEARS ____

FIRST TIME WHEN STARTED LIVING WITH (FIRST) SPOUSE/PARTNER 96

411. How long ago did you last have sexual intercourse?
RECORD IN YEARS ONLY IF LAST TIME WAS OVER A YEAR AGO. IF 12 MONTHS OR LONGER, THE RESPONSE SHOULD BE RECORDED IN YEARS.

DAYS AGO 1 ____
WEEKS AGO 2 ____
MONTHS AGO 3 ____
YEARS AGO 4 ____ (GO TO 420)

412. The last time that you had intercourse, was a condom used?

YES 1
NO 2 (GO TO 413)

412A. What is the main reason that you chose to use a condom at this time?

RESPONDENT WANTED TO AVOID STD'S/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STD'S/AIDS AND PREGNANCY 3
DID NOT TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) ____ 7

413. What is the relationship with the woman with whom you had sexual intercourse?
IF "GIRLFRIEND" OR "FIANCE," ASK: Did your girlfriend/fianc? live with you when you last had sexual intercourse? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

COHABITING WITH WIFE/PARTNER 1 (GO TO 415)
GIRLFRIENCE/FIANCE 2
FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
CLIENT (PROSTITUTION) 6
OTHER (SPECIFY) ____ 7

414. How long have you been having sexual intercourse with this woman?

NUMBER OF DAYS 1 ____
NUMBER OF WEEKS 2 ____
NUMBER OF MONTHS 3 ____
NUMBER OF YEARS 4 ____

415. In the past 12 months, have you had sexual intercourse with any other woman?

YES 1
NO 2 (GO TO 420)

416. The last time you had sexual intercourse with another woman, was a condom used?

YES 1
NO 2 (GO TO 417)

416A. What is the main reason that you used a condom at this time?

RESPONDENT WANTED TO AVOID STD'S/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STD'S/AIDS AND PREGNANCY 3
DOESN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) ____ 7

417. What was your relationship with this woman?
IF "GIRLFRIEND" OR "FIANCE", ASK: Did your girlfriend/fianc? live with you when you last had intercourse with her? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

COHABITING WITH SPOUSE/PARTNER 1 (GO TO 418A)
GIRLFRIEND/FIANCE 2
FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
CLIENT (PROSTITUTION) 6
OTHER (SPECIFY) ____ 7

418. How long have you been having sexual intercourse with this woman?

NUMBER OF DAYS 1 ____
NUMBER OF WEEKS 2 ____
NUMBER OF MONTHS 3 ____
NUMBER OF YEARS 4 ____

418A. Besides these two women, have you had sexual intercourse with anyone else in the past twelve months?

YES 1
NO 2 (GO TO 420)

418B. The last time that you had sexual intercourse with this other woman, was a condom used?

YES 1
NO 2 (GO TO 418D)

418C. What is the main reason that you used a condom at this time?

RESPONDENT WANTED TO AVOID STD'S/AIDS 1
RESPONDENT WANTED TO AVOID PREGNANCY 2
RESPONDENT WANTED TO AVOID BOTH STD'S/AIDS AND PREGNANCY 3
DOESN'T TRUST PARTNER/SUSPECTS PARTNER HAS OTHER PARTNERS 4
PARTNER INSISTED 5
DOESN'T KNOW 6
OTHER (SPECIFY) _____

418D. What is your relationship with this woman?
IF "GIRLFRIEND" OR "FIANCE", ASK: Did your girlfriend/fianc? live with you when your last had sexual intercourse? IF YES, CIRCLE '1'. IF NO, CIRCLE '2'.

COHABITING WITH SPOUSE/PARTNER 1 (GO TO 418A)
GIRLFRIEND/FIANCE 2
FRIEND 3
CASUAL ACQUAINTANCE 4
RELATIVE 5
CLIENT (PROSTITUTION) 6
OTHER (SPECIFY) ____ 7

418E. How long have you had sexual intercourse with this woman?

NUMBER OF DAYS 1 ____
NUMBER OF WEEKS 2 ____
NUMBER OF MONTHS 3 ____
NUMBER OF YEARS 4 ____

419. In total, how many different woman (besides your spouse) have you had sex with in the past 12 months?

NUMBER OF PARTNERS ____

420. Do you know of a place where a person can get condoms?

YES 1
NO 2 (GO TO 501)

421. Where is this?
Anywhere else?
RECORD ALL MENTIONED.

IF IT IS A HOSPITAL, A HEALTH CENTER OR A CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE ______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
PMI/MATERNITY D
MOBILE CLINIC E
FIELD WORKER F
OTHER PUBLIC FACILITY (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELD WORKER K
OTHER PRIVATE MEDICAL FACILITY (SPECIFY) ____ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH WORKER N
COMMUNITY DISTRIBUTION WORKERS/MATRON/BIRTH ATTENDANT/NURSE'S AIDE O
SEMI-PUBLIC SECTOR
INPS/CMIE (NATIONAL INSTITUTE FOR SOCIAL PLANNING/INTER-OFFICE MEDICAL CENTER) P
MUTEC (EDUCATION AND CULTURE WORKERS MUTUAL) Q
OTHER (SPECIFY) ____ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL HEALER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) _____ X

422. If you wanted, could you get yourself a condom?

YES 1
NO 2
DOESN'T KNOW/NOT SURE 8

SECTION 5. FERTILITY PREFERENCES

501. CHECK 401:

NOT IN UNION OR FIRST UNION NOT CONSUMMATED (GO TO 501A)
CURRENTLY MARRIED OR LIVING WITH A WOMAN (GO TO 501B)

501A. CHECK 411:

LAST HAD SEX LESS THAN 12 MONTHS AGO, OR CODE '1', '2', OR '3' CIRCLED (GO TO 501B)

LAST HAD SEX 12 MONTHS OR LONGER, OR CODE '4' CIRCLED OR 411 NOT ASKED (GO TO 502(A))

501B. Is your spouse/partner (or one of your spouses/partners) currently pregnant?

YES 1
NO 2 (GO TO 502(A))
UNSURE 8 (GO TO 502(A))

501C. When she became pregnant, did you want her to be pregnant then, did you want to wait until later, or did you not want her to be pregnant at all?

THEN 1 (GO TO 502(B))
LATER 2 (GO TO 502(B))
NOT AT ALL 3 (GO TO 502(B))

502(A). SPOUSE/PARTNER ISN'T PREGNANT OR UNSURE OR NO SPOUSE/PARTNER: Now, I would like to ask you questions about the future. Would you like to have a (another) child, or would you prefer to not have any (more) children?

HAVE A (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 504)
WIFE/PARTNER CANNOT GET PREGNANT 3 (GO TO 514)
UNDECIDED/DOESN'T KNOW AND PREGNANT 4 (GO TO 510)
NOT PREGNANT OR UNSURE 5 (GO TO 504)

502(B) SPOUSE/PARTNER PREGNANT. After the child that you are expecting, would like to have another child or would you prefer not to have any more children?

HAVE A (ANOTHER) CHILD 1
NO MORE/NONE 2 (GO TO 504)
WIFE/PARTNER CANNOT GET PREGNANT 3 (GO TO 514)
UNDECIDED/DOESN'T KNOW AND PREGNANT 4 (GO TO 510)
NOT PREGNANT OR UNSURE 5 (GO TO 504)

503. CHECK 502:

SPOUSE/PARTNER NOT PREGNANT OR UNSURE OR NO SPOUSE/PARTNER: How long would you like to wait before the birth of a (another) child?

SPOUSE/PARTNER PREGNANT: After the birth of the child you are expecting now, how long would you like to wait before the birth of another child?

MONTHS ____
YEARS ____

SOON/NOW 993 (GO TO 510)
SAYS SHE CANNOT GET PREGNANT 994 (GO TO 514)
AFTER MARRIAGE 995 (GO TO 509)
OTHER (SPECIFY) ____ 996 (GO TO 508)
DOESN'T KNOW 998 (GO TO 508)

504. CHECK 502:

SPOUSE/PARTNER NOT PREGNANT OR UNSURE OR NO SPOUSE/PARTNER (GO TO 505)

SPOUSE/PARTNER PREGNANT (GO TO 510)

505. CHECK 307:
CURRENTLY USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 506)
NO, NOT CURRENTLY USING (GO TO 506)
YES, CURRENTLY USING (GO TO 508)

506. CHECK 503:

NOT ASKED (GO TO 508)
24 MONTHS OR MORE, OR 2 YEARS OR LONGER (GO TO 508)
00-23 MONTHS OR 00-01 YEARS (GO TO 510)

508. In the coming weeks, if you discovered that one of your spouses/partners was pregnant, would it be a big problem, a small problem, or no problem at all?

BIG PROBLEM 1
SMALL PROBLEM 2
NO PROBLEM 3
SAYS WIFE CANNOT GET PREGNANT/NOT HAVING SEX 4

509. CHECK 307:
CURRENTLY USING A CONTRACEPTIVE METHOD?

NOT ASKED (GO TO 510)
NO, NOT CURRENTLY USING (GO TO 510)
YES, CURRENTLY USING (GO TO 514)

510. Do you think that, at any time in the future, you will use a contraceptive method to delay or avoid a pregnancy?

YES 1
NO 2 (GO TO 512)
DOESN'T KNOW 8 (GO TO 512)

511. Which contraceptive method would you prefer to use?

FEMALE STERILIZATION 01 (GO TO 514)
MALE STERILIZATION 02 (GO TO 514)
PILL 03 (GO TO 514)
IUD/COIL 04 (GO TO 514)
INJECTIONS 05 (GO TO 514)
IMPLANTS 06 (GO TO 514)
CONDOM 07 (GO TO 514)
FEMALE CONDOM 08 (GO TO 514)
DIAPHRAGM 09 (GO TO 514)
FOAM OR JELLY 10 (GO TO 514)
AMEN. LACT. METHOD 11 (GO TO 514)
RHYTHM METHOD 12 (GO TO 514)
WITHDRAWAL 13 (GO TO 514)
OTHER (SPECIFY) ____ 96 (GO TO 514)
UNSURE 98 (GO TO 514)

512. What is the main reason why you think that you will never use a contraceptive method at any time in the future?

NOT MARRIED 11
FERTILITY-RELATED REASONS
NO SEX/DOESN'T HAVE FREQUENT SEX 22 (GO TO 514)
MENOPAUSE/HYSTERECTOMY 23 (GO TO 514)
SUB-FECUND/STERILE 24 (GO TO 514)
WANTS AS MANY CHILDREN AS POSSIBLE 26 (GO TO 514)
OPPOSITION TO USE
RESPONDENT OPPOSED 31 (GO TO 514)
SPOUSE/PARTNER OPPOSED 32 (GO TO 514)
OTHER PERSON(S) OPPOSED 33 (GO TO 514)
RELIGIOUS PROHIBITION 34 (GO TO 514)
LACK OF KNOWLEDGE
DOESN'T KNOW OF ANY METHOD 41 (GO TO 514)
DOESN'T KNOW OF ANY SOURCE 42 (GO TO 514)
METHOD-RELATED REASONS
HEALTH CONCERNS 51 (GO TO 514)
FEAR OF SIDE EFFECTS 52 (GO TO 514)
INACCESSIBLE/TOO FAR 53 (GO TO 514)
TOO EXPENSIVE 54 (GO TO 514)
INCONVENIENT TO USE 55 (GO TO 514)
INTERFERES WITH BODY'S NATURAL PROCESSES 56 (GO TO 514)
OTHER (SPECIFY) ____ 96 (GO TO 514)
DOESN'T KNOW 98 (GO TO 514)

513. Would you ever use a contraceptive method if you were married?

YES 1
NO 2
DOESN'T KNOW 8

514. CHECK 203 AND 205:

HAS LIVING CHILDREN: If you could go back to the time you did not have any children and choose exactly the number of children to have in your whole life, how many would that be?

DOESN'T HAVE LIVING CHILDREN: If you could choose exactly the number of children to have in your whole life, how many would that be?

PROBE TO OBTAIN A NUMERICAL RESPONSE.
IF NONE, CIRCLE '00' AND GO TO 516.

NONE 00 (GO TO 516)

NUMBER ____

OTHER (SPECIFY) ____ 96 (GO TO 516)

515. Among these children, how many would you like to be boys, how many would you like to be girls, and for how many would the sex not matter?

NUMBER OF BOYS ____
NUMBER OF GIRLS ____
DOESN'T MATTER ____
OTHER (SPECIFY) ____ 96

516. Would you say that you approve or disapprove of couples that use a contraceptive method to avoid pregnancy?

APPROVE 1
DISAPPROVE 2
DOESN'T KNOW/UNSURE 8

517. Over the past month, have you heard of family planning:

On the radio?
On the television?
In newspapers or magazines?
On a poster?
In a flyer or brochure?
In a cultural/educational group session?
At school?

RADIO
YES 1
NO 2
TELEVISION
YES 1
NO 2
NEWSPAPER OR MAGAZINES
YES 1
NO 2
POSTER
YES 1
NO 2
FLYER
YES 1
NO 2
CULTURAL SESSION
YES 1
NO 2
AT SCHOOL
YES 1
NO 2

518. To you, is it acceptable or unacceptable to talk about family planning:

On the radio?
On the television?
In newspapers or magazines?
On a poster?
In a flyer or brochure?
In a cultural/educational group session?
At school?

RADIO
ACCEPTABLE 1
UNACCEPTABLE 2
TELEVISION
ACCEPTABLE 1
UNACCEPTABLE 2
NEWSPAPER OR MAGAZINES
ACCEPTABLE 1
UNACCEPTABLE 2
POSTER
ACCEPTABLE 1
UNACCEPTABLE 2
FLYER
ACCEPTABLE 1
UNACCEPTABLE 2
CULTURAL SESSION
ACCEPTABLE 1
UNACCEPTABLE 2
AT SCHOOL
ACCEPTABLE 1
UNACCEPTABLE 2

519. In the past 12 months, have you discussed the practice of family planning with your friend(s), your neighbor(s), or your relative(s)?

YES 1
NO 2 (GO TO 521)

520. With whom did you discuss this? Anyone else?
RECORD ALL MENTIONED.

SPOUSE/PARTNER A
MOTHER B
FATHER C
SISTER(S) D
BROTHER(S) E
COUSIN(S) F
DAUGHTER(S) G
SON(S) H
MOTHER(S)-IN-LAW I
FRIEND(S)/NEIGHBOR(S) J
OTHER (SPECIFY) ____ X

521. CHECK 401:

YES, CURRENTLY MARRIED (GO TO 522)
YES, LIVING WITH A WOMAN (GO TO 522)
NO, NOT IN A UNION OR FIRST UNION NOT CONSUMMATED (GO TO 528)

522. CHECK 308/308A:

AT LEAST ONE CODE CIRCLED (GO TO 523)
NO CODE CIRCLED (GO TO 524)

523. You told me that you are currently using a family planning method. Would you say that the decision to use a method was mainly your decision, mainly your spouse('s/s')/live-in partner('s/s') decision, or did you decide together?

MAINLY HIMSELF 1
MAINLY SPOUSE/PARTNER 2
JOINT DECISION 3
OTHER (SPECIFY) ____ 6

Now, I would like to ask you about the opinions of your spouse(s)/partner(s) in family planning.

524. Do you think that your spouse(s)/live-in partner(s) approve(s) or disapprove(s) of couples that use a contraceptive method to avoid pregnancy?

APPROVES 1
DISAPPROVES 2
DOESN'T KNOW 8

525. How often, in the past 12 months, have you talked about family planning with your spouse(s)/partner(s) that you live with?

NEVER 1
ONE OR TWO TIMES 2
MORE OFTEN 8

526. CHECK 308/308A:

CODE 'B' NOT CIRCLED OR NOT STERILIZED (GO TO 527)
CODE 'B' CIRCLED OR STERILIZED (GO TO 528)

527. Do you think that your spouse(s)/live-in partner(s) want(s) the same number of children as you, more children than you, or fewer children than you?

SAME NUMBER 1
MORE CHILDREN 2
FEWER CHILDREN 3
DOESN'T KNOW 8

528. Sometimes husbands and wives do not agree on everything. Please tell me if you think it is okay that a wife refuses sex with her husband when:

She knows that her husband/partner has a sexually transmitted disease?
She knows that her husband/partner has sex with other women other than spouses?
She has recently given birth?
She is tired or not in the mood?

HAS AN STD
YES 1
NO 2
DOESN'T KNOW 8
OTHER WOMEN
YES 1
NO 2
DOESN'T KNOW 8
RECENTLY GAVE BIRTH
YES 1
NO 2
DOESN'T KNOW 8
TIRED/NOT IN THE MOOD
YES 1
NO 2
DOESN'T KNOW 8

SECTION 6. AIDS AND OTHER SEXUALLY TRANSMITTED DISEASES

Now, I want to talk about something else.

601. Have you heard of the illness called AIDS?

YES 1
NO 2 (GO TO 617)

602. Is there anything a person can do to avoid contracting AIDS or the virus that causes AIDS?

YES 1
NO 2 (GO TO 609)
DOESN'T KNOW 8 (GO TO 609)

603. What can be done?
Anything else?
RECORD ALL THAT IS MENTIONED.

ABSTAIN FROM SEX A
USE CONDOMS B
LIMIT TO ONE PARTNER/STAY LOYAL TO ONE PARTNER C
LIMIT NUMBER OF SEXUAL PARTNERS D
AVOID SEX WITH PROSTITUTES E
AVOID SEX WITH PERSONS WITH MULTIPLE PARTNERS F
AVOID SEX WITH HOMOSEXUALS G
AVOID SEX WITH PERSONS THAT INJECT THEMSELVES WITH DRUGS H
AVOID BLOOD TRANSFUSIONS I
AVOID INJECTIONS J
AVOID SHARING SYRINGES/BLADES/RAZORS K
AVOIDING KISSING L
AVOID MOSQUITO BITES M
SEEK PROTECTION FROM A TRADITIONAL HEALER N
OTHER (SPECIFY) ____ W
OTHER (SPECIFY) ____ X
DOESN'T KNOW Z

604. Can person reduce their chance of getting AIDS by having only one sexual partner that who has no other partners?

YES 1
NO 2
DOESN'T KNOW 8

605. Can people contract AIDS if they are bitten by mosquitoes?

YES 1
NO 2
DOESN'T KNOW 8

606. Can people reduce their chance of getting AIDS by using a condom every time they have sex?

YES 1
NO 2
DOESN'T KNOW 8

607. Can people contract AIDS by sharing food with someone who has AIDS?

YES 1
NO 2
DOESN'T KNOW 8

608. Can people protect themselves from AIDS by completely abstaining from sex?

YES 1
NO 2
DOESN'T KNOW 8

609. Is it possible that a person who appears to be healthy, in fact, has the AIDS virus?

YES 1
NO 2
DOESN'T KNOW 8

610. Do you personally know someone that has the AIDS virus or that has died from AIDS?

YES 1
NO 2

611. Can the virus that causes AIDS be transmitted from mother to her infant?

YES 1
NO 2 (GO TO 613)
DOESN'T KNOW 8 (GO TO 613)

612. The virus that causes AIDS can be transmitted from mother to her baby:

During pregnancy?
During birth delivery?
During breastfeeding?

DURING PREGNANCY
YES 1
NO 2
DOESN'T KNOW 8
DURING BIRTH DELIVERY
YES 1
NO 2
DOESN'T KNOW 8
DURING BREASTFEEDING
YES 1
NO 2
DOESN'T KNOW 8

613. CHECK 301:

CURRENTLY MARRIED/LIVING WITH A WOMAN (GO TO 614)
NO, NOT IN UNION OR FIRST UNION NOT CONSUMMATED (GO TO 615A)

614. Have you ever talked about how to avoid contracting the AIDS virus with your spouse(s)/live-in partner(s)?

YES 1
NO 2

615A. In your opinion, is it acceptable or unacceptable to talk about AIDS:

On the radio?
On television?
In newspapers or magazines?
On posters?
In flyers/brochures?
In cultural/educational group sessions?
At school?

ON THE RADIO
ACCEPTABLE 1
UNACCEPTABLE 2
ON TELEVISION
ACCEPTABLE 1
UNACCEPTABLE 2
IN NEWSPAPERS
ACCEPTABLE 1
UNACCEPTABLE 2
ON POSTERS
ACCEPTABLE 1
UNACCEPTABLE 2
IN BROCHURES
ACCEPTABLE 1
UNACCEPTABLE 2
CULTURAL SESSIONS
ACCEPTABLE 1
UNACCEPTABLE 2
AT SCHOOL
ACCEPTABLE 1
UNACCEPTABLE 2

615B. If a person learns that he/she is infected by the virus that causes AIDS, should this person be permitted to keep it a secret or should it be communicated to the community?

BE KEPT A SECRET 1
BE SHARED WITH THE COMMUNITY 2
DOESN'T KNOW/UNSURE 8

616. If someone in your family contracted the virus that causes AIDS, would you be willing to take care of him/her in your household?

YES 1
NO 2
DOESN'T KNOW/UNSURE/IT DEPENDS 8

617A. If a female teacher had the AIDS virus but doesn't seem sick, should she be allowed to continue teaching at the school?

SHOULD BE ALLOWED 1
SHOULD NOT BE ALLOWED 2
DOESN'T KNOW/UNSURE/IT DEPENDS 8

617B. Should children aged 12-14 be educated on how to use a condom to avoid contracting the AIDS virus?

YES 1
NO 2
DOESN'T KNOW/UNSURE/IT DEPENDS 8

617C. Have you ever been tested for the AIDS virus?

YES 1 (GO TO 617FX)
NO 2

617D. Would you like to be tested for the AIDS virus?

YES 1
NO 2
DOESN'T KNOW/UNSURE 8

617E. Do you know of a place where you can be tested for AIDS?

YES 1
NO 2 (GO TO 617)

617F. Where can you get tested?
Anywhere else?
RECORD ALL THAT IS MENTIONED.

IF IT IS A HOSPITAL, A HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE TYPE OF SECTOR AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
PMI/MATERNITY D
MOBILE CLINIC E
FIELD WORKER F
OTHER PUBLIC (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ____ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH WORKER N
COMMUNITY DISTRIBUTION WORKERS/MATRON/BIRTH ATTENDANT/NURSE'S AIDE O
SEMI-PUBLIC SECTOR
INPS/CMIE (NATIONAL INSTITUTE FOR SOCIAL PLANNING/INTER-OFFICE MEDICAL CENTER) P
MUTEC (EDUCATION AND CULTURE WORKERS MUTUAL) Q
OTHER (SPECIFY) _____ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL HEALER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) _____ X

617FX. Where did you get tested?

IF IT IS A HOSPITAL, A HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE ESTABLISHMENT. PROBE TO DETERMINE THE SECTOR TYPE AND CIRCLE THE APPROPRIATE CODE.

NAME OF PLACE _______
PUBLIC SECTOR
GOVERNMENT HOSPITAL A
GOVERNMENT HEALTH CENTER B
FAMILY PLANNING CLINIC C
PMI/MATERNITY D
MOBILE CLINIC E
FIELD WORKER F
OTHER PUBLIC (SPECIFY) ____ G
PRIVATE MEDICAL SECTOR
CLINIC H
PHARMACY I
PRIVATE DOCTOR J
FIELD WORKER K
OTHER PRIVATE MEDICAL (SPECIFY) ____ L
COMMUNITY SECTOR
HEALTH CENTER M
HEALTH WORKER N
COMMUNITY DISTRIBUTION WORKERS/MATRON/BIRTH ATTENDANT/NURSE'S AIDE O
SEMI-PUBLIC SECTOR
INPS/CMIE (NATIONAL INSTITUTE FOR SOCIAL PLANNING/INTER-OFFICE MEDICAL CENTER) P
MUTEC (EDUCATION AND CULTURE WORKERS MUTUAL) Q
OTHER (SPECIFY) _____ R
OTHER SOURCE
SHOP/MARKET S
TRADITIONAL HEALER T
CHURCH U
RELATIVES/FRIENDS V
OTHER (SPECIFY) _____ X

617. (Apart from AIDS), have you heard of (other) infections that can be transmitted by sex?

YES 1
NO 2 (GO TO 620A)

618. If a man has a sexually transmitted disease, what symptoms might he have?
Any other sign or symptom?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
IMPOTENCE L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DOESN'T KNOW Z

619. If a woman has a sexually transmitted disease, what symptoms might she have?
Any other sign or symptom?
RECORD ALL MENTIONED.

ABDOMINAL PAIN A
GENITAL DISCHARGE B
FOUL-SMELLING DISCHARGE C
BURNING URINATION D
GENITAL REDNESS/INFLAMMATION E
GENITAL SWELLING F
GENITAL SORE/ULCER G
GENITAL WARTS H
GENITAL ITCHING I
BLOOD IN URINE J
WEIGHT LOSS K
HARD TO GET PREGNANT/HAVE A CHILD L
OTHER (SPECIFY) _____ W
OTHER (SPECIFY) _____ X
NO SYMPTOMS Y
DOESN'T KNOW Z

620A. CHECK 410:

HAS HAD SEXUAL INTERCOURSE (GO TO 620AA)
HAS NOT HAD SEXUAL INTERCOURSE (GO TO 701)

620AA. CHECK 617:

HAS HEARD OF STD'S (GO TO 620B)
HAS NOT HEARD OF STD'S (GO TO 620C)

Now, I would like to ask you questions about your health in the last 12 months.

620B. During the last 12 months, have you had a disease which you got through sexual contact?

YES 1
NO 2
DOESN'T KNOW 8

620C. Sometimes men have abnormal discharge from their penis. In the last 12 months, have you have any abnormal discharge from your penis?

YES 1
NO 2
DOESN'T KNOW 8

620D. Sometimes men have a sore or ulcer near their penis. During the last 12 months, have you had a sore or ulcer near your penis?

YES 1
NO 2
DOESN'T KNOW 8

620E. CHECK 620B, 620C, AND 620D:

HAS HAD AN INFECTION (GO TO 620F)
HAS NOT HAD AN INFECTION (GO TO 701)

620F. The last time you had (INFECTION FROM 620B, 620C, OR 620D), did you seek any kind of advice or treatment?

YES 1
NO 2 (GO TO 620H)

620G. The last time you had (INFECTION FROM 620B, 620C, OR 620D), did you do any of the following thing? Did you?

Seek advice from a health worker in a clinic or a hospital?
Seek advice or treatment from a traditional healer?
Seek advice or purchase drugs from a shop or a pharmacy?
Seek advice from friends or relatives?

CLINIC/HOSPITAL
YES 1
NO 2
TRADITIONAL HEALER
YES 1
NO 2
SHOP/PHARMACY
YES 1
NO 2
FRIENDS/RELATIVES
YES 1
NO 2

620H. When you had (INFECTION FROM 620B, 620C, OR 620D), did you inform the woman/women that you were having sexual intercourse with?

YES 1
NO 2
SOME WOMEN/NOT ALL 3

620I. When you had (INFECTION FROM 620B, 620C, OR 620D), did you do something to avoid infecting your sexual partner(s)?

YES 1
NO 2 (GO TO 701)
PARTNER(S) ALREADY INFECTED 3 (GO TO 701)

620J. What did you do to prevent infection in your partner(s)? Did you?

Stop sexual intercourse?
Use a condom during sexual intercourse?
Take drugs?

STOPPED HAVING SEX
YES 1
NO 2
USED CONDOM
YES 1
NO 2
TOOK DRUGS
YES 1
NO 2

SECTION 7. FEMALE CIRCUMCISION

701. Have you ever heard of female circumcision?

YES 1 (GO TO 703)
NO 2

702. In a number of countries, including Mali, there is a practice in which a girl may have part of her genitals cut. Have you ever heard of this practice?

YES 1
NO 2 (GO TO 709)

703. What benefits do girls get if they undergo this genital cutting?
PROBE: Any other benefits?
RECORD ALL MENTIONED.

BETTER HYGIENE A
SOCIAL ACCEPTANCE B
BETTER CHANCE OF MARRIAGE C
PRESERVE VIRGINITY/PREVENT PREMARITAL SEX D
MORE SEXUAL PLEASURE FOR HUSBAND E
RELIGIOUS REQUIREMENT F
OTHER (SPECIFY) _____ X
NO BENEFITS Y

704. What benefits do girls get if they do not undergo this genital cutting?
PROBE: Anything else?
RECORD ALL MENTIONED.

FEWER MEDICAL PROBLEMS A
AVOIDING PAIN B
MORE SEXUAL PLEASURE FOR HER C
MORE SEXUAL PLEASURE FOR THE MAN D
FOLLOWS RELIGION E
OTHER (SPECIFY) _____ X
NO BENEFITS Y

705. Would you say that this practice is a way to prevent a girl from having sex before marriage or does it have no effect on premarital sex?

PREVENTS SEX 1
NO EFFECT 2
DOESN'T KNOW 8

706. Do you believe that this practice is required by your religion?

YES 1
NO 2
DOESN'T KNOW 8

707. Do you think that this practice should be continued, or should it be discontinued?

CONTINUED 1
DISCONTINUED 2
IT DEPENDS 3
DOESN'T KNOW 8

708. Do you think that women want this practice to be continued, or discontinued?

CONTINUED 1
DISCONTINUED 2
IT DEPENDS 3
DOESN'T KNOW 8

709. RECORD THE TIME.

HOUR _____
MINUTES _____

INTERVIEWER OBSERVATIONS

TO BE FILLED OUT AFTER COMPLETING THE INTERVIEW.

COMMENTS ABOUT THE RESPONDENT _____
COMMENTS ON SPECIFIC QUESTIONS _____
OTHER COMMENTS _____

SUPERVISOR'S OBSERVATIONS _____
NAME _____
DATE _____

FIELD EDITOR'S OBSERVATIONS _____
NAME _____
DATE _____